Testosterone

What Is Testosterone?

Testosterone is a sex hormone that's also available as a prescription
medicine to treat male hypogonadism and symptoms of low testosterone
levels ("low T").

Symptoms of low T may include sexual dysfunction, low energy, and the
loss of some male characteristics.

Testosterone works by supplanting the body's natural production of
testosterone.

Testosterone medications come in the form of gels, topical solutions,
transdermal patches placed on the skin, buccal patches applied to the
upper gums,
injections, and pellets implanted under the skin.

The hormone is also used off-label to treat erectile dysfunction (ED),
hypogonadism in older men, and sexual problems in women.

Both men and women produce testosterone, with levels in men naturally
higher.

Low T is caused by male hypogonadism, when the testes produce little or
no sex hormones, including testosterone.

This may result because of a problem with the testes themselves
(primary hypogonadism) or because of problems in areas of the brain
that control hormones,
including the hypothalamus and pituitary gland (hypogonadotropic
hypogonadism).

The Food and Drug Administration FDA) originally approved testosterone
in 1953.

In 2014, the FDA narrowed the number of conditions that testosterone
could be marketed to treat.

Drug makers could label and advertise their hormone products to treat
"classic" hypogonadism (primary and hypogonadotropic hypogonadism), but
not
age-related hypogonadism, because of a debate that low T in old age
might be naturally protective.

The FDA also announced in 2014 that it was investigating the safety of
testosterone drugs regarding their potential to increase the risk of
strokes, heart
attacks, and deaths.

Testosterone Warnings

The testosterone gel and topical solution come with a black-box warning
about the risk posed to children who are accidentally exposed to the
hormone.
Exposure can lead to "virilization," resulting in:

Penis or clitoris enlargement

Pubic hair growth

Increased erections and libido

Aggression

Aging of bones

These products should be applied to body areas not likely to come in
contact with children or pregnant women, and the application site
should be covered
with clothing.

Hands should be washed with soap and water before and after
application, and the application site should be washed before any
skin-to-skin contact.

If accidental skin-to-skin contact occurs with another person, the
affected areas should be washed immediately.

Tell anyone else who handles things that may have testosterone on them
(such as your bed sheets and pillows or clothing) that they need to be
careful of
exposure.

You should not use any testosterone product if you have breast cancer
or if you have or may have prostate cancer.

Use of testosterone may:

Increase your risk of prostate cancer

Worsen the symptoms of enlarged prostate (such as urinary
problems)

Cause edema (swelling from the buildup of fluids), which
may be
accompanied by congestive heart failure (the inability of your heart to
pump enough blood
for your body) if you have heart, liver, or kidney disease

Cause sleep apnea, especially if you are very overweight or
have
chronic lung disease

Cause gynecomastia (enlarged breast tissue) to develop or
persist

Reduce sperm count

Cause severe gum irritation (if using the buccal system)

Cause blood clots in the veins to develop, and arteries in
the lungs
to become blocked up

Testosterone topical gel and solution are flammable when wet. The
aluminum present in the transdermal testosterone system may cause skin
burns if used
during a magnetic resonance imaging (MRI) scan.

In 2014, the FDA began investigating whether testosterone treatments
raise the risk of heart attacks, strokes, or death, which some research
has indicated.

Pregnancy and Testosterone

Testosterone is an FDA Pregnancy Category X drug -- it should never be
used by pregnant women because it can harm developing fetuses.

Though it's not known how much testosterone is excreted in human milk,
breastfeeding women shouldn't use the drug because of the potential
harm it poses to
infants. Testosterone is also known to negatively affect lactation.

Women who are pregnant should be especially careful about exposure to
men using topical testosterone.

Testosterone for Women

Though testosterone is often considered a male sex hormone, it's also
produced in small amounts by female adrenal glands and ovaries, and it
may be linked
to women's sex drive.

The hormone is sometimes prescribed off-label to improve sexual desire
in women who no longer have ovaries or have ovaries that aren't
working.

Testosterone is also sometimes prescribed to treat symptoms of
menopause.

Testosterone Interactions

Before taking testosterone, you should tell your doctor about any
treatments you're taking or undergoing, including prescription,
non-prescription, or
over-the-counter (OTC) medications, illegal or recreational drugs,
herbal remedies, or nutritional and dietary supplements.

Be sure to mention if you are taking:

Insulin (such as Apridra, Humulin, Novolin, and others),
because
testosterone may change your ability to control blood-glucose levels
and sensitivity to
insulin

Oral anticoagulants or blood-thinners, such as warfarin
(Coumadin)

Corticosteroids, such as prednisone (Rayos) and
methylprednisolone
(Medrol)

Missed Dose of Testosterone

Testosterone FAQ

Q: I'm getting testosterone shots. Do they causes weight gain?

A: While a little bit of weight gain may be possible with testosterone, a large amount of weight gain is not normal and should be reported to your physician.

Q: What does testosterone do? I think of it as controlling mood, sex drive, and motivation.

A: Testosterone is the male androgen, or sex hormone. It controls too many things to list here. While it does help regulate mood, sex drive, and metabolism, it does this by working in tandem with other hormones in your body. It's produced by the male testes and the adrenal glands. For more information, go to http://www.everydayhealth.com/drugs/testosterone.
Matt Curley, PharmD

Q: What are the long-term side effects from testosterone? I have been on it for a little over seven years.

A: According to the package insert, there are several longer-term side effects that have occurred with testosterone therapy. Testosterone can stimulate the growth of cancerous tissue. Prostate cancer or enlargement of the prostate can develop during prolonged therapy with testosterone, and these conditions are more likely to occur in elderly men. In patients receiving testosterone therapy, tests for prostate cancer should be performed as is current practice. Androgen therapy, such as testosterone, can cause a loss of blood sugar control in patients with diabetes. Close monitoring of blood glucose is recommended. Male patients can experience feminization during prolonged therapy with testosterone. The side effects of feminization include breast soreness and enlargement. These side effects are generally reversible when treatment is stopped. Hair loss resembling male pattern baldness has also occurred. Sexual side effects including decreased ejaculatory volume and low sperm counts have occurred in patients receiving long-term therapy or excessive doses. For more information, please consult with your health care provider and visit http://www.everydayhealth.com/drugs/testosterone. Michelle McDermott, PharmD

Q: What would be the difference between testosterone and Depo-Testosterone?

A: Depo-Testosterone is a brand name medication that contains testosterone cypionate. Depo-Testosterone is given as an intramuscular injection. The medication is indicated for replacement therapy for men that have conditions associated with symptoms of deficiency in the hormone or absence of testosterone produced in the body. Conditions that can be associated with low testosterone include: delayed puberty, impotence and hormonal imbalances. Testosterone is a sex hormone that is naturally produced in the male testicles. In women, small amounts of testosterone is produced in the ovaries and by the adrenal system. Testosterone is available in various medications for testosterone replacement therapy. Different forms of testosterone (e.g. cypionate, enanthate etc) are contained in different brand name medications. Jen Marsico, RPh

Q: My testosterone level is 240. What do you recomment to get it back up to the 300+ level?

A: According to the NIH, normal values for testosterone levels in men can range from 300 to 1,200ng/dL. There can be many different causes of low testosterone including age, diseases, accidents, and medications. Symptoms of low testosterone may include: loss of sex drive, erectile dysfunction, depressed mood, and difficulty concentrating. Low testosterone levels may also bring around body changes including: hair loss, decrease in blood cells possibly leading to anemia, fragile bones, and a decrease in muscle mass. There are different testosterone replacement therapies including patches, such as Androderm; gels, such as Androgel and Testim; and injections, such as testosterone cypionate. Only your health care provider can decide if and what kind of testosterone replacement therapy is appropriate for you. Testosterone replacement therapy is not right for everyone. Patient with certain prostate issues or breast cancer should not take testosterone. For more specific information, consult with your doctor for guidance based on your health status and current medications, particularly before taking any action. Kristen Dore, PharmD

A: Endocrinology is a very difficult subject, some physicians and pharmacists alike have more difficulty with endocrinology than neurology. The reason for this is that there is no clear cut answer. Every hormone interacts with another hormone system in the body whether it be parathyroid hormone, cortisol, follicle stimulating hormone, etc. By in large, testosterone will increases lean body mass, which is to say that it typically increases muscle and or bone mass. We use it in the hospital to put weight on in patients needing to gain weight. That is partially the reason why we refer to testosterone as an "anabolic" hormone; anabolic meaning 'to build'. For more information, please visit us here at: http://www.everydayhealth.com/drugs/testosterone Matt Curley, PharmD

Q: Is troche safe to take for erectile dysfunction?

A: A troche is a small lozenge designed to dissolve in the mouth. Testosterone is available in troche or buccal form. If you are referring to testosterone troche, this product is generally used to treat conditions in men that result from a lack of natural testosterone. Testosterone is vital to maintaining an active and healthy male sex drive. Testosterone deficiency can cause erectile dysfunction. Studies suggest that if erectile dysfunction is associated with a low testosterone level, it can often be treated with prescription testosterone pills. Based on your complete medical history and blood levels of testosterone, your doctor can determine the best treatment option to meet your needs. For more information, please consult with your health care provider and visit http://www.everydayhealth.com/drugs/testosterone.
Michelle McDermott, PharmD

Q: A 38 year old male started a testosterone patch two weeks ago, as levels were low according to a blood test. It seems like he has gained a lot of weight, and it looks like muscle mass. Could this be the case?

A: Testosterone products can improve a male's muscle strength and create a more lean body mass. Typically, these effects are not noticed within the first two weeks of therapy, but it is possible that he is more sensitive and responds well to the therapy. Some of the other more common side effects of testosterone patches are headache, depression, rash, changes in libido, acne, male pattern baldness, and increased cholesterol levels. This is not a complete list of the side effects associated with testosterone patches. Megan Uehara, PharmD

Q: What medications are available to treat low testosterone?

A: Testosterone production declines naturally with age. Low testosterone, or testosterone deficiency (TD), may result from disease or damage to the hypothalamus, pituitary gland, or testicles that inhibits hormone secretion and testosterone production. Treatment involves hormone replacement therapy. The method of delivery is determined by age and duration of deficiency. Oral testosterone, Testred (methyltestosterone), is associated with liver toxicity and liver tumors and so is prescribed sparingly. Transdermal delivery with a testosterone patch is becoming the most common method of treatment for testosterone deficiency in adults. A patch is worn, either on the scrotum or elsewhere on the body, and testosterone is released through the skin at controlled intervals. Patches are typically worn for 12 or 24 hours and can be worn during exercise, bathing, and strenuous activity. Two transdermal patches that are available are Androderm (nonscrotal) and Testoderm (scrotal). The Androderm patch is applied to the abdomen, lower back, thigh, or upper arm and should be applied at the same time every evening between 8 p.m. and midnight. If the patch falls off before noon, replace it with a fresh patch until it is time to reapply a new patch that evening. If the patch falls off after noon, do not replace it until you reapply a new patch that evening. The most common side effects associated with transdermal patch therapy include itching, discomfort, and irritation at the site of application. Some men may experience fluid retention, acne, and temporary abnormal breast development (gynecosmastia). AndroGel and Testim are transdermal gels that are applied once daily to the clean dry skin of the upper arms or abdomen. When used properly, these gels deliver testosterone for 24 hours. The gel must be allowed to dry on the skin before dressing and must be applied at least 6 hours before showering or swimming. Gels cannot be applied to the genitals. AndroGel is available in a metered-dose pump, which allows physicians to adjust the dosage of the medication. Side effects of transdermal gels include adverse reactions at the site of application, acne, headache, and hair loss (alopecia). For more specific information on treatments for low testosterone, consult with your doctor or pharmacist for guidance based on current health condition. Kimberly Hotz, PharmD

Q: I have low T. My doctor has prescribed AndroGel. This drug costs $244 each month with my insurance. Is there another drug that is cheaper? Should I switch to shots? Are shots cheaper?

A: If a health insurance company is providing coverage for a medication, including testosterone replacement therapy, they determine the final cost of the product. Costs will vary from one health insurance plan to another. To determine the costs of the testosterone replacement options, the health insurance plan should be contacted. There are various options for testosterone replacement therapy including gels, injections, patches, and tablets that dissolve under the lip. All of the formulations can be effective and each has advantages and disadvantages. The most appropriate testosterone replacement therapy depends on a variety of factors, including cost, patient preference, and tolerability. Testosterone replacement gels, such as AndroGel and Testim, are very effective and easy to administer. AndroGel and Testim can be easily applied to the skin once daily. However, the gels can be irritating to the skin and AndroGel and Testim are typically quite expensive. Testosterone replacement injections, such as Depo-Testosterone (testosterone cypionate) and Delatestryl (testosterone enanthate), are usually inexpensive. The injections are given only once every one to two weeks. The major disadvantage with injectable testosterone is that testosterone levels may be difficult to control. Levels may be too high after an injection and too low before the following injection. A testosterone replacement patch, such as Androderm, is applied every night and left on for 24 hours. Androderm can be applied to the arm, back or stomach, in an area without too much hair. Androderm can cause irritation of the skin. A testosterone tablet, Striant, is placed under the upper lip against the gums and replaced every 12 hours. Striant molds to the upper gum so that eating and drinking can occur normally. The testosterone tablet can irritate the gums and cause a bitter taste and toothache. People with low testosterone should work with their doctor or healthcare provider to find a safe, effective, and affordable testosterone replacement option for them. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Derek Dore, PharmD

Q: I was put on Androderm twice and both times I had weak erections and depressed thoughts. Is this related to using testosterone? It happens right after I apply it, within 24 hours.

A: Androderm comes in the form of a transdermal patch and is used for testosterone replacement therapy in patients who have insufficient levels of testosterone. Testosterone is a hormone produced in the body that plays a key role in many physiological processes in men. In some men, however, the body does not produce enough of the hormone, resulting in a variety of symptoms including decreased libido, erectile dysfunction, muscle loss, anemia and depression, among others. Androderm helps treat these symptoms and raise low testosterone levels by delivering therapeutic amounts of the hormone, which are absorbed through the skin. According to the prescribing information for Androderm, depression was a reported side effect of the medication. Other common side effects of Androderm include itching and redness at the application site, prostate abnormalities, headache, and burning or hardening of the skin at the application site. Less common side effects of Androderm include reduced libido (sex drive), fatigue, high blood pressure, anxiety, confusion, increased appetite, and body pain. For more specific information, consult with your doctor for guidance based on your health status and current medications, particularly before taking any action. Your physician can determine if your dosage of the medication needs to be adjusted or if an alternative medication should be considered. Lori Poulin, PharmD

Q: Is there anything over-the-counter to increase testosterone?

A: There are no over-the-counter products approved by the U.S. Food and Drug Administration (FDA) to increase testosterone levels. There are several prescription medication options available. Please consult with your health care provider in regards to your testosterone levels and to determine which treatment option best meets your individual needs. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Kristen Dore, PharmD

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